title: Needle-free jet injection of rapid-acting insulin improves early postprandial glucose control in patients with diabetes.
abstract: OBJECTIVE
  Clamp studies have shown that the absorption and action of rapid-acting insulin are faster with injection by a jet injector than with administration by conventional pen. To determine whether these pharmacokinetic changes also exist in patients with diabetes and benefit postprandial glucose control, we compared the pharmacologic profiles of insulin administration by jet injection versus conventional insulin pen after a standardized meal in patients with type 1 or type 2 diabetes.
  
  
  METHODS
  In a randomized, double-blind, double-dummy crossover study, 12 patients with type 1 diabetes and 12 patients with type 2 diabetes received insulin aspart either by jet injection or by conventional pen, in both cases followed by a standardized meal. Blood was sampled for 6 h for determination of glucose and insulin levels to calculate pharmacologic profiles.
  
  
  RESULTS
  Insulin administration by jet injection resulted in shorter time until peak plasma insulin level (51.3 ± 6.4 vs. 91.9 ± 10.2 min; P = 0.003) and reduced hyperglycemic burden during the first hour (154.3 ± 20.8 vs. 196.3 ± 18.4 mmol · min · L(-1); P = 0.041) compared with conventional administration. Jet injection did not, however, significantly reduce the hyperglycemic burden during the 5-h period thereafter. There was no indication that the jet injector performed differently in patients with type 1 and type 2 diabetes.
  
  
  CONCLUSIONS
  The considerably more rapid insulin absorption after administration by jet injector translated to a significant if modest decrease in postprandial hyperglycemia in patients with type 1 and type 2 diabetes. The improved early postprandial glucose control may specifically benefit patients who have difficulty in limiting postprandial glucose excursions.
authors.affiliation: Corresponding author: Bastiaan E. de Galan, b.degalan@aig.umcn.nl.
authors.forename: Elsemiek E C
authors.initials: EE
authors.lastname: Engwerda
authors.forename: Cees J
authors.initials: CJ
authors.lastname: Tack
authors.forename: Bastiaan E
authors.initials: BE
authors.lastname: de Galan
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D018592:Cross-Over Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007277:Injections, Jet; D061267:Insulin Aspart / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D061266:Insulin, Short-Acting; D008297:Male; D008875:Middle Aged; D009339:Needles; D019518:Postprandial Period / Q000187:drug effects; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D061266:Insulin, Short-Acting; D061267:Insulin Aspart